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Horizontal Inequity in Access to Health Care in Four South American Cities


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  • Ana I. Balsa


  • Máximo Rossi


  • Patricia Triunfo



ResumenEl objetivo de este trabajo es analizar el grado de inequidad socioeconómica en el uso de servicios médicos de la población adulta mayor en cinco ciudades latinoamericanas (Buenos Aires, Ciudad de México, Santiago de Chile, San Pablo y Montevideo), en base a los datos de la Encuesta de Salud, Bienestar y Envejecimiento relevada entre 1999 y 2000 (SABE, OPS/OMS, 2001). El análisis imputa el ingreso equivalente del hogar a través de la utilización de las encuestas de hogares de los distintos países, y considerando una amplia serie de indicadores de acceso, calidad y uso de servicios de salud. Una vez estandarizado el uso de servicios por las necesidades de cuidados, se encuentran desigualdades socioeconómicas pro-rico en el uso de servicios preventivos en todas las ciudades, desigualdades en la realización de visitas médicas en Santiago y Montevideo, y desigualdades en la calidad de acceso a la atención en todas las ciudades salvo Montevideo. Las desigualdades socioeconómicas dentro de los sistemas de salud públicos o privados explican una mayor proporción de las desigualdades en el acceso a la atención. Nuestros resultados son informativos en el contexto de las políticas recientes destinadas a la aplicación de paquetes mínimos de servicios. AbstractThe objective of this paper is compare socioeconomic inequalities in the use of healthcare services in four South-American cities: Buenos Aires, Santiago, Montevideo, and San Pablo. We use secondary data from SABE, a survey on Health, Well-being and Aging administered in 2000 under the sponsorship of the Panamerican Health Organization, and representative of the elderly population in each of the analyzed cities. We construct concentration indices of access to and quality of healthcare services, and decompose them in socioeconomic, need, and non-need contributors. We assess the weight of each contributor to the overall index and compare indices across cities. Our results show high levels of pro-rich socioeconomic inequities in the use of preventive services in all cities, inequities in medical visits in Santiago and Montevideo, and inequities in quality of access to care in all cities but Montevideo. Socioeconomic inequality within private or public health systems explains a higher portion of inequalities in access to care than the fragmented nature of health systems. Our results are informative given recent policies aimed at enforcing minimum packages of services and given policies exclusively focused on defragmenting health systems.

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Volume (Year): (2011)
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Handle: RePEc:col:000151:008956

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Keywords: Desigualdad horizontal; acceso al sistema de salud; Suramérica.;

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  1. Wagstaff, Adam, 2002. "Inequality aversion, health inequalities, and health achievement," Policy Research Working Paper Series, The World Bank 2765, The World Bank.
  2. Wagstaff, Adam & van Doorslaer, Eddy & Paci, Pierella, 1991. "On the measurement of horizontal inequity in the delivery of health care," Journal of Health Economics, Elsevier, Elsevier, vol. 10(2), pages 169-205, July.
  3. Pilar Garcia-Gomez & Erik Schokkaert & Tom Van Ourti & Teresa Bago d'Uva, 2012. "Inequity in the Face of Death," Tinbergen Institute Discussion Papers, Tinbergen Institute 12-084/3, Tinbergen Institute.
  4. VAN OURTI, Tom, 2002. "Measuring horizontal inequity in health care using Belgian panel data," Working Papers, University of Antwerp, Faculty of Applied Economics 2002034, University of Antwerp, Faculty of Applied Economics.
  5. Wagstaff, Adam & Van Doorslaer, Eddy & Watanabe, Naoko, 2001. "On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam," Policy Research Working Paper Series, The World Bank 2714, The World Bank.
  6. Bertranou, Fabio M., 1999. "Are market-oriented health insurance reforms possible in Latin America?: The cases of Argentina, Chile and Colombia," Health Policy, Elsevier, Elsevier, vol. 47(1), pages 19-36, April.
  7. Leu, Robert E. & Schellhorn, Martin, 2004. "The Evolution of Income-Related Inequalities in Health Care Utilization in Switzerland over Time," IZA Discussion Papers 1316, Institute for the Study of Labor (IZA).
  8. van Doorslaer, Eddy & Wagstaff, Adam, 1992. "Equity in the delivery of health care: some international comparisons," Journal of Health Economics, Elsevier, Elsevier, vol. 11(4), pages 389-411, December.
  9. Wagstaff, Adam & van Doorslaer, Eddy & Paci, Pierella, 1989. "Equity in the Finance and Delivery of Health Care: Some Tentative Cross-country Comparisons," Oxford Review of Economic Policy, Oxford University Press, Oxford University Press, vol. 5(1), pages 89-112, Spring.
  10. Eddy van Doorslaer & Xander Koolman & Andrew M. Jones, 2004. "Explaining income-related inequalities in doctor utilisation in Europe," Health Economics, John Wiley & Sons, Ltd., John Wiley & Sons, Ltd., vol. 13(7), pages 629-647.
  11. Hugh Gravelle, 2003. "Measuring income related inequality in health: standardisation and the partial concentration index," Health Economics, John Wiley & Sons, Ltd., John Wiley & Sons, Ltd., vol. 12(10), pages 803-819.
  12. Morris, Stephen & Sutton, Matthew & Gravelle, Hugh, 2005. "Inequity and inequality in the use of health care in England: an empirical investigation," Social Science & Medicine, Elsevier, Elsevier, vol. 60(6), pages 1251-1266, March.
  13. Adam Wagstaff & Eddy van Doorslaer, 2000. "Measuring and Testing for Inequity in the Delivery of Health Care," Journal of Human Resources, University of Wisconsin Press, University of Wisconsin Press, vol. 35(4), pages 716-733.
  14. Robert E. Leu & Martin Schellhorn, 2004. "The evolution of income-related inequalities in health care utilization in Switzerland over time," Diskussionsschriften, Universitaet Bern, Departement Volkswirtschaft dp0413, Universitaet Bern, Departement Volkswirtschaft.
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Cited by:
  1. Damiano, Fiorillo & Fabio, Sabatini, 2011. "Quality and quantity: the role of social interactions in individual health," MPRA Paper 29777, University Library of Munich, Germany.


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